Provider Demographics
NPI:1881571990
Name:MATATOV, ADINA
Entity type:Individual
Prefix:
First Name:ADINA
Middle Name:
Last Name:MATATOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10706 QUEENS BLVD APT 4H
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4268
Mailing Address - Country:US
Mailing Address - Phone:917-999-6027
Mailing Address - Fax:
Practice Address - Street 1:10706 QUEENS BLVD APT 4H
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4268
Practice Address - Country:US
Practice Address - Phone:917-999-6027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral